Drug failure patient noncompliance

The directions for use (element [11]) must be both drug-specific and patient-specific. The simpler the directions, the better and the fewer the number of doses (and drugs) per day, the better. Patient noncompliance (also known as nonadherence, failure to adhere to the drug regimen) is a major cause of treatment failure. To help patients remember to take their medications, prescribers often give an instruction that medications be taken at or around mealtimes and at bedtime. However, it is important to inquire about the patient s eating habits and other lifestyle patterns, because many patients do not eat three regularly spaced meals a day. 

Patients with peptic ulcer disease who develop recurrent ulcer signs or symptoms of Cl bleeding or perforation should be referred to a specialist. Assess reasons for therapeutic failure, including noncompliance to the drug regimen, antibiotic resistance (HPeradication), heavy smoking, NSAID use, and the need for HP eradication in a patient on conventional antiulcer medications. 

Routine monitoring of plasma concentrations of antidepressants, while technically feasible for most drugs, is of uncertain value (except for nortriptyline). However, studies suggest that at least 20% of patients become noncompliant at some time or other. Thus, a "poor response" in a patient for whom an adequate dosage of drug has been prescribed may be shown by measurement of the plasma drug concentration to be due merely to failure to take the drug. 

Noncompliance is an important cause of lack of response to drugs. Patients should be warned also that noticeable improvement may be slow, perhaps taking 3 weeks or more. Inability to tolerate adverse effects and discouragement with treatment are two major causes for noncompliance and for failure of antidepressants to show efficacy. 

Eactors involved in precipitating decompensation have been evaluated prospectively in patients admitted to the hospital with heart faUure. ° These studies consistently show that noncompliance with drugs or diet is a common cause of heart failure exacerbation. Eor example, 43% of patients admitted with an acute decompensation of chronic heart failure were assessed as having dietary sodium excess, 34% had excess fluid intake (defined as >2.5 L/day), and about 24% had drug noncompliance that may have contributed to their decompensation (although not necessarily defined as the primary cause of decompensation). Use of inappropriate medications such as antiar-rhythmic agents or calcium channel blockers also was an important precipitant of exacerbations. 

Medication noncompliance may be the single most common reason for treatment failure. It is estimated that up to 60% of patients with epilepsy are noncompliant. " The rate of noncompliance is increased by the complexity of the drug regimen and by doses taken three and four times a day. Noncompliance is not influenced by age, sex, psychomotor development, seizure type, or seizure frequency. " ... 

It is important to simplify the treatment regimen and to ensure that the patient is receiving the drug. In cases of suspected severe and dangerous noncompliance or with failure of oral treatment, the patient can be treated with injections of fluphenazine decanoate, haloperidol decanoate, or other long-acting preparations, including risperidone microspheres. 

Even the most carefully prepared prescription for the ideal therapy will be useless if the patient s level of compliance is inadequate. Noncompliance, thought to occur 50% of the time, may be manifest in drug therapy as intentional or accidental errors in dosage or schedule, overuse, underuse, early termination of therapy, or not having a prescription filled. Noncompliance always should be considered in evaluating therapeutic failures. 

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